Provider Demographics
NPI:1295128783
Name:ASHIROV, AZIZ A (CRNA)
Entity type:Individual
Prefix:
First Name:AZIZ
Middle Name:A
Last Name:ASHIROV
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 PORTER LAKE DR
Mailing Address - Street 2:201
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-1265
Mailing Address - Country:US
Mailing Address - Phone:407-408-6716
Mailing Address - Fax:
Practice Address - Street 1:395 PORTER LAKE DR
Practice Address - Street 2:201
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-1265
Practice Address - Country:US
Practice Address - Phone:407-408-6716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-09
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT132882163W00000X
MARN2300423163W00000X, 367500000X
CT6492367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110122909AMedicaid